OBJECTIVES: Rheumatoid arthritis (RA) is a chronic illness that implies high direct and indirect costs for the health system, particularly when biological therapy is prescribed. The aim of this study was to evaluate the cost-utility of etanercept, adalimumab and infliximab for the treatment of rheumatoid arthritis (RA) in Colombian adult population. METHODS: A cost-utility analysis was performed from a Markov model using 3-month cycles, assuming adult patients with RA treated for the first time with anti-TNF drugs, in combination with methotrexate (MTX). The time horizon was 2 years and we used the third party payer perspective. The model was built using effectiveness, safety and utility measures taken from international registers and clinical trials. Costs were gathered locally and results are expressed in 2010 Colombian pesos; utility was measured in quality-adjusted life-years (QALY) derived from ACR50 response, compliances rates and adverse events incidence. Drug costs (fixed by regulations from Ministry of Social Protection) as well as treatment costs of moderate and serious adverse events mainly tuberculosis, pneumonia and cancer included; finally a univariate sensitivity analysis was carried out. RESULTS: QALY’s gained with etanercept, adalimumab and infliximab were 1.4689, 1.4627 and 1.4340, respectively; and mean estimated costs resulted in US$41, 050, US$43,175 and US$47,190, respectively. Etanercept was the cost-saving strategy, with a cost-effectiveness ratio of US$27,945/QALY vs. US$29,520/QALY and US$32,910/QALY in comparison to adalimumab and infliximab, explained by providing a better safety profile, better adherence to treatment and lower drug costs. The key variables in sensitivity analysis were: drug costs, frequency of adverse events and compliance rates, and conclusions were unaffected, even when using extreme values, supporting the robustness of the model. CONCLUSIONS: Treatment of RA with etanercept+MTX is the dominant combination in Colombia, against adalimumab+MTX or infliximab+MTX, by providing more QALYs gained at lower cost.